Organization
MENDOCINO OPTICAL CO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE MARIE NIX LDO (OWNER OPTICIAN)
(707) 462-2744
Entity
Organization
Contact information
Practice address
5120 HILL RD E, LAKEPORT, CA 95453-6300
(707) 263-3433
(707) 263-9340
Mailing address
280 S SCHOOL ST, UKIAH, CA 95482-4828
(707) 462-2744
(707) 462-8789
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
D5447
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1974
MESC BLUE SHIELD
CA
Enumeration date
08/12/2008
Last updated
08/12/2008
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